Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication

Aarnink, EW; Maarse, M; Fierro, N; Mazzone, P; Beneduce, A; Tondo, C; Gasperetti, A; Pracon, R; Demkow, M; Zieliński, K; de Backer, O; Korsholm, K; Nielsen-Kudsk, JE; Estévez-Loureiro, R; Caneiro-Queija, B; Benito-González, T; Pérez de Prado, A; Nombela-Franco, L; Salinas, P; Holmes, D; Almakadma, AH; Berti, S; Romeo, MR; Millan, X; Arzamendi, D; Alla, VM; Agarwal, H; Eitel, I; Paitazoglou, C; Freixa, X; Cepas-Guillén, P; Chothia, R; Badejoko, SO; Spoon, DB; Maddux, JT; El-Chami, M; Ram, P; Branca, L; Adamo, M; Suradi, HS; Peper, J; van Dijk, VF; Rensing, BJWM; Swaans, MJ; Vireca, E; Bergmann, MW; Boersma, LVA; STR-OAC LAAO and EWOLUTION Investigators

doi:10.1016/j.jcin.2024.04.012

Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication

JACC Cardiovasc IntervPublished 22 May 2024Propensity-score matched comparison of an international left atrial appendage occlusion (LAAO) collaboration with the EWOLUTION registry

Main finding · Ischemic strokeResultHazard ratio 1.37 95% CI 0.72–2.61

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Authors' conclusion

LAAO in patients with a thrombotic event on OAT demonstrated comparable stroke rates to the OAT contraindicated population in EWOLUTION. The thromboembolic event rate was higher and the bleeding rate lower, reflecting the intrinsically different risk profile of both populations.

Study context

Population: Atrial fibrillation (AF) patients undergoing LAAO438 matched pairs
Participants: 438 vs 438

Exposure: LAAO for thrombotic event on OAC vs LAAO for OAC contraindication
STR-OAC LAAOn = 438
EWOLUTIONn = 438reference
Outcome: Ischemic stroke

Methodological detailscomparison with historical data

Comparison with historical data

Main finding

As reported in the abstract

Hazard ratio

1.37

95% CI 0.72–2.61

By group

STR-OAC LAAO2.5%

EWOLUTION1.9%

STR-OAC LAAOvs EWOLUTION

HR 1.37 (95% CI 0.72–2.61)

Observational data: associations, not effects.

Further findings

Outcome	← Lower risk with STR-OAC LAAO ←→ Higher risk with STR-OAC LAAO →	HR (95% CI)
Thromboembolic risk	0.20.5125	1.71 (1.04–2.83)
	0.20.5125Hazard ratio (log scale)

Mortality

P = 0.028

STR-OAC LAAO4.3%

EWOLUTION6.9%

Relative risk reduction

Outcome	STR-OAC LAAO	EWOLUTION
Ischemic stroke RRR vs historical data without OACBased on risk scores	70%	78%

Safety

Outcome	← Lower risk with STR-OAC LAAO ←→ Higher risk with STR-OAC LAAO →	HR (95% CI)
Bleeding risk	0.20.5125	0.39 (0.18–0.88)
	0.20.5125Hazard ratio (log scale)

Reference

Authors: Aarnink EW, Maarse M, Fierro N, Mazzone P, Beneduce A, Tondo C, et al.
All 48 authors
Aarnink EW, Maarse M, Fierro N, Mazzone P, Beneduce A, Tondo C, Gasperetti A, Pracon R, Demkow M, Zieliński K, de Backer O, Korsholm K, Nielsen-Kudsk JE, Estévez-Loureiro R, Caneiro-Queija B, Benito-González T, Pérez de Prado A, Nombela-Franco L, Salinas P, Holmes D, Almakadma AH, Berti S, Romeo MR, Millan X, Arzamendi D, Alla VM, Agarwal H, Eitel I, Paitazoglou C, Freixa X, Cepas-Guillén P, Chothia R, Badejoko SO, Spoon DB, Maddux JT, El-Chami M, Ram P, Branca L, Adamo M, Suradi HS, Peper J, van Dijk VF, Rensing BJWM, Swaans MJ, Vireca E, Bergmann MW, Boersma LVA, STR-OAC LAAO and EWOLUTION Investigators
Journal: JACC: Cardiovascular Interventions
Published: 22 May 2024
DOI: 10.1016/j.jcin.2024.04.012
PubMed: 38795093

Topic: Arrhythmias & electrophysiology
Also indexed: Interventional cardiology

Exposure definitions

STR-OAC LAAO: LAAO because of thrombotic events on OAC
EWOLUTION: LAAO because of OAC contraindications

Key notes

No significant difference
Matched cohort

Original publication

Left Atrial Appendage Occlusion in Patients With Anticoagulation Failure vs Anticoagulation Contraindication. JACC Cardiovasc Interv. Published 22 May 2024. doi:10.1016/j.jcin.2024.04.012

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